Hypertension is called high blood pressure, which is the pressure exerted by the blood on the walls of the arteries as it flows through them. It depends on the blood flow, i.e. how much blood the heart sends in each contraction, but also on the resistance that the vessels present to this flow. If this pressure is high, then the heart has to work harder to maintain adequate blood flow to the body. It is important to note that it does not concern cases where elevated blood pressure is justified, such as during intense physical exercise or under stressful conditions, but when it occurs systematically and without justification.

Untreated hypertension gradually turns the arteries from elastic and inner to hard and inelastic, vulnerable to injury and atherosclerosis, greatly increasing the risk of heart disease, stroke, kidney dysfunction, eye problems and neurological disorders.

What we want to know and what we need to know about blood pressure is answered by Mr. Athanasios Manolis Director of the 2nd Cardiology Clinic and Hypertension Center Metropolitan Hospital, Professor in the Department of Hypertension at Boston University and member of the Board of Directors of the European Society of Hypertension.

What is systolic and diastolic pressure?

The heart “beats” more than 100,000 times a day, and each time it “beats”, it pushes a quantity of blood into our arteries, putting pressure on them. Between two beats the heart rests and fills with blood. Thus blood pressure is expressed by two numbers:

• The first number is the pressure exerted by the blood on the artery wall as it leaves the heart. His name is systolic pressure or large.
• The second number is the pressure exerted by the blood on the walls of the arteries when the heart is at rest. His name is diastolic pressure or small.

What causes high blood pressure?

Usually, blood pressure rises over the years without any apparent cause, with the majority of hypertensives (95%) showing so-called “idiopathic” hypertension associated with factors such as: advanced age, improper diet, obesity, long-term intake of an increased amount of salt, a sedentary lifestyle, lack of exercise or the continuous adoption of unhealthy habits, such as smoking. This high blood pressure is called essential hypertension. It usually appears after the age of 30, but it can occur even in children. In people with hypertension in both parents, the probability of developing hypertension exceeds 70%. In people with a hypertensive parent the probability is about 30% and in those without hypertensive parents it reaches about 15%.

In a few cases, in a percentage of about 5%, it may indicate another potential cause or be due to a specific disease, (such as renal artery stenosis, chronic kidney disease, apnea or the presence of adrenal disease) it is called secondary hypertension, and it requires appropriate tests. Other rare causes are primary aldosteronism, pheochromocytoma, Cushing’s syndrome, and aortic isthmus stenosis. However, these cases are rare compared to cases of essential hypertension.

Is hypertension hereditary?

It seems that there is a deep connection between hypertension, as well as other diseases such as diabetes mellitus and high cholesterol, and heredity. If parents have high blood pressure from a relatively young age, children seem to have an increased risk of developing hypertension, that is, a predisposition to it. However, there are many external factors that can exacerbate this possibility, and their proper management can prevent or reduce elevated blood pressure. These factors include:

• High alcohol consumption
• Smoking
• Increased body weight and obesity
• Lack of exercise and fixed life
• Excessive salt consumption

What symptoms does high blood pressure cause?

Despite popular belief to the contrary, high blood pressure rarely presents with symptoms. For this reason, it is vital to check our blood pressure periodically, for example every 6 months or annually, even if we are not experiencing any symptoms. Blood pressure measurement is a critical component of the cardiac examination, and it is not uncommon for elevated blood pressure to be discovered during a screening even when the patient is unaware of a problem and has not previously been measured.

In extremely rare cases of severe hypertensive crisis (with values ​​above 200 mmHg), headache, visual disturbances, vomiting or chest pain may occur. In patients with pre-existing severe heart disease, pulmonary edema or heart attack may occur. However, the feasibility and practicality of these changes must be considered in order to sustain them in the long term. If the pressure remains high, the use of antihypertensive drugs is recommended. The doctor will adjust the treatment, taking into account the history and test findings to achieve normal blood pressure levels.

How do we measure blood pressure correctly?

To measure blood pressure correctly, follow the steps below.

• Avoid drinking coffee, caffeinated drinks/soft drinks and smoking for 30 minutes before the measurement.
• Sit comfortably, feet firmly on the ground, and relax for 5 minutes.
• Prefer a certified sphygmomanometer, with an arm cuff rather than a wrist cuff
• Loosen the arm from tight clothing.
• Rest your hand on a stable spot and always measure in the same hand – usually the one in which you notice the highest pressure. The first time the measurement should be done on both hands.
• Choose the correct cuff size according to your arm circumference to avoid measurement errors. Consult your doctor or pharmacist.
• Ignore the first measurement and then repeat two more times 1-2 minutes apart. Calculate the average and record the value.
• If you measure the blood pressure at home the pressure should be measured twice and we take the average of the two readings.
• Note the time of the last antihypertensive medication.
Before visiting your doctor to adjust your antihypertensive treatment, it is important to record your readings twice a day for at least three days:
• In the morning, after getting up, before taking antihypertensive treatment and before breakfast.
• In the evening, before the evening meal.

In addition to traditional recording on a chart or diary, there are also digital mobile apps you can use to record and send results to your doctor before your visit. Pressure units are millimeters of mercury (mmHg).

What are the desired blood pressure limits?

The desired blood pressure in healthy adults should be below 140 mmHg systolic and below 90 mmHg diastolic. Any blood pressure value that exceeds 140 mmHg for systolic and 90 mmHg for diastolic is considered hypertension. In people receiving antihypertensive treatment the pressure should not be reduced to values ​​lower than 120 mm Hg, while in people over 80 years the pressure at levels of 140-150 mmHg is acceptable. In particular, people with blood pressure values ​​between 120-139 for systolic and/or 85-89 for diastolic are considered to have borderline hypertension (pre-hypertension) and need regular monitoring of their blood pressure, as well as immediate adjustment of their lifestyle . However, it is important to note that blood pressure does not remain constant throughout the day, so its diagnosis must be based on multiple measurements.

How is high blood pressure treated?

The first move after detecting high blood pressure is to change our daily life in order to reduce it, taking measures such as:

• Losing excess weight: There is a link between weight and blood pressure, with obesity being able to cause sleep apnea, raising the pressure. Losing every kilogram can lower blood pressure by about 1mmHg.
• Physical exercise: Aerobic exercise for 30 minutes, five times a week, can lower blood pressure by about 8 mmHg, in addition to other health benefits.
• Healthy diet and salt restriction: A diet rich in fruits, vegetables, whole grains and low in saturated fat can lower blood pressure by about 11 mmHg.
• Stop smoking: Smoking directly and long-term increases blood pressure, worsening the deterioration of arteries.
• Limiting alcohol consumption: Drinking more than 1-2 glasses of wine per day can lead to an increase in blood pressure.
• Dealing with stress: Anxiety and depression are associated with increased blood pressure, so managing stress is important.

Should I stop my hypertension medication when my blood pressure is regulated?

Unlike drugs such as antibiotics or anti-inflammatories, we do not stop antihypertensive treatment once blood pressure regulation is achieved. We must continue taking the treatment according to the specific schedule and dosage in order to keep the pressure at normal levels. However, there is the possibility of reducing the dosage if we achieve significant changes in diet, body weight or smoking, always following the instructions of our doctor.

Should I take the antihypertensive drug only when I have high blood pressure?

It is recommended to take the antihypertensive drug daily, regardless of whether the blood pressure is high or not, in order to keep it constantly at regulated levels. An exception can only be made if the doctor has a specific reason to suggest otherwise.

What is gestational hypertension?

During pregnancy, hypertension can occur in approximately 5-10% of pregnancies. Although it is not necessarily life-threatening, it requires careful monitoring and cooperation between the gynecologist and the cardiologist in order to ensure the health of the woman and the newborn. A woman with a history of hypertension, whether with or without treatment, should see her doctor before or at the start of pregnancy for a baseline screening, instructions on monitoring, and necessary adjustments to medication. Getting this treatment right is extremely important, as we now know that some medications are safer for the newborn than others that may be harmful.

During pregnancy, it is necessary to regularly monitor blood pressure readings. If the repeated measurements exceed the values ​​of 140/90 mmHg, it is recommended that the woman visit her doctor. In this case, she will receive instructions and possibly start medication with drugs that are safe for mother and child.

*The Hypertension Clinic of the Metropolitan Hospital emerged as the first hypertension clinic in a private hospital in Greece and abroad, certified as a Center of Excellence in Hypertension by the European Society of Hypertension (June 2021). Also, Metropolitan Hospital is the first hospital in the private sector that participates in the writing of hypertension guidelines worldwide. This certification highlights the Hypertension Clinic for its innovative activity and the excellent quality and efficiency of its services in the research, diagnosis, treatment and treatment of hypertension.